UNICEF and the Global Goals

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In India, pregnancy comes with a high price

Vairabhi Majhi lies with her newborn child in a government-run primary health facility in India's Orissa state. She is suffering from anaemia and malaria.

By Sarah Crowe

UNICEF and other international leaders in maternal health and child survival met 7-9 June in Washington, DC, to accelerate a global campaign aimed at reducing deaths of pregnant women and young children. Here is one in a series of related stories.

KHARIAR, India, 11 June 2010 – Her face contorted in pain, Triveni Patel, 27, hobbled into the health centre in an advanced stage of labour with her mother-in-law at her side. Ms. Patel was suffering from acute complications and dangerously high blood pressure. She was frighteningly close to death.

Lacking the necessary resources to address her complications, Ms. Patel’s local government-run health facility couldn’t help her. Instead, the staff there referred her to a private hospital nearby. The young woman boarded a taxi and took off through the cows and rickshaws in a race against time.

Lack of timely care

Ms. Patel had tried unsuccessfully to have a baby for seven years. Now, at the end of her long-awaited pregnancy, a dangerous condition known as eclampsia threatened her life – and that of her unborn baby.

After an agonizing birth and complications due to eclampsia, Triveni Patel, 27, delivered a healthy child in Orissa state, India.

In India’s Orissa state, where Ms. Patel lives, up to eight mothers die every day giving birth.

More than two-thirds of all maternal deaths in India occur in just a handful of impoverished states, including Orissa, and the inability to get medical care in time is one of the major factors contributing to this tragedy. Many maternal deaths here occur when women give birth at home. Husbands are frequently responsible for preventing their wives from getting expensive medical care.

The high prevalence of child marriage – which encourages pregnancy at a young age – also adds to the health crisis facing Indian women.

Challenge in remote areas

After the 15-minute taxi ride to the private hospital, Ms. Patel was admitted and her condition stabilized.

Purna Marji holds his year-old son, Santosh, in Sialanati village in the tribal interiors of Orissa state, India. His wife died four days after giving birth to Santosh.

Back at the health centre, however, another young mother battled common complications. Two hours after giving birth, Vairabhi Majhi could not lift her baby to breastfeed. She was found to be anaemic and suffering from malaria. Without treatment, she, too, could die.

The region’s high maternal mortality rate is especially challenging for India’s most far-flung tribal areas. In Nuaparha district, in the north of Orissa state, Purna Marji, 40, has lived alone in the since his wife died tragically after childbirth. She had malaria and couldn’t get to a clinic on time.

Her infant child, Santosh, and his two brothers are cared for by Purna’s brother and sister-in-law, who have three boys of their own. Another mouth to feed is a struggle for the family of subsistence farmers.

“Since their mother is not there, the children are helpless, and really feel her absence," said Mr. Marji.

‘Pregnancy is not a disease’

UNICEF and its partners are committed to avoiding these preventable maternal deaths.

“We need an army of front-line workers to reach those women,” said UNICEF Senior Health Specialist Dr. Jorge Caravotta. He added that while good referrals and transport systems are important to ensuring a higher survival rate, better-equipped facilities throughout the country are absolutely essential.

“Otherwise, the pregnant woman will be referred from one facility to another – a never-ending process up to the moment she dies,” said Dr. Caravotta.

Some innovative schemes – including a conditional cash transfer programme for women who deliver in health facilities – are starting to improve the situation. But many experts believe that investment in midwifery is the key to revolutionizing India’s maternal health landscape.

“What India needs now is a professional cadre of midwives,” said UNICEF Maternal and Women’s Health Specialist Kimberly Allen. When combined with referrals for complicated cases, she noted, midwives help more women deliver safely and with dignity.

“Pregnancy is not a disease,” said Ms. Allen. “No woman should ever have to die giving birth.”